the appropriate anti-lithics-great caution however is necessary here in prescribing either an acid or alkali; for whenever that natural acidity of the urine is destroyed which is necessary for keeping the phosphoric salts in solution, we shall produce a sabulous deposit. Where an acid is indicated the hydrochloric or nitric are as effectual as any that can be given.

With respect to the means by which calculous deposits, retained in the body, may be removed, there is considerable difficulty, in as much as the resistance caused by the cohesive power and the small surface which they present to the decomposing agent, render such a concentration of chemical power necessary for their solution, as neither the stomach nor bladder could bear with impunity. However, though we may not succeed in materially affecting large concretions, we may make an impression on small calculi, so as to blunt their sharp edges, and cause them to be discharged by the urethra with less difficulty; we may even convert a rough into a smooth calculus, and we may prevent its further increase by modifying the character of the urine, but great care and judgment are necessary to accomplish this. If a lithic acid calculus be present in the bladder, its increase may be prevented by alkalies, but should these be carried too far, we shall cause a deposit of the phosphates.

The mineral acids seem to exert a greater solvent influence on phosphatic calculi, than the alkalies do on those of the lithic acid. The injection of dilute nitric acid through the urethra into the bladder has been tried by Sir B. Brodie and has proved successful. This method is peculiarly deserving attention, as being an application in cases in which neither lithotomy, nor lithotrity can be employed with safety or success, viz. in cases of the deposition of the phosphates, accompanied with a diseased state of the prostate and bladder.

We find we have gone so far in our analysis of this work that we must stop short here. The author we find has made several emendations in this edition which must considerably enhance its value-he has done more ; he has incorporated several of Liebig's new views on the actions of substances taken into the system. His remarks on the action of diuretic medicines, on the most judicious and appropriate method of selecting them so as to suit the particular case, are invaluable to the practitioner; indeed this one section leaves Dr. Paris's book without a rival. The section on Antilithics and Lithonthryptics contains valuable rules and directions well deserving careful and attentive perusal. The subject of Urinary Diseases is treated with peculiar clearness and great judgment; in fact this part of the work may be considered an excellent analysis of the best works we possess on this important class of diseases; more especially of the works of Sir B. Brodie and Dr. Prout-in short we may sum up our opinion of Dr. Paris's ninth edition of his Pharmacologia in three words; decies repetita placebit,

Before quitting the Doctor, however, we have one word to say to him regarding his Greek-at page 87, he gives in a note a passage from the Hecuba of Euripides, Scil. νασμος μελαναυγης, not μελαναυγες, as the Doctor has it, and he favours his readers with a translation of it; he renders it, black-flowing splendour-surely the least reflexion would have shown him that to such words no rational idea can be annexed-black-flowing splendour is decided nonsense-and we assure Dr. Paris that it is not "all the same

in the Greek"-the obvious and simple meaning of the words is, blackshining stream. It is astonishing that this error pervades all the former editions. We apprehend Dulces reminiscitur Argos will not be predicated of Dr. Paris after such a specimen.

A PRACTICAL TREATISE ON THE DISEASES PECULIAR TO WOMEN. By Samuel Ashwell, M.D. Part II. pp. 250, 8vo. 1843. THIS is a continuation of the Work we had occasion to speak very favorably of in our Number for January 1841. It completes the subject of functional and commences that of organic diseases of the internal genitals. A part to be published soon will complete the latter, and treat of the affections of the external parts. The analysis we propose to give demands all our space.

HYSTERIA.

Hysteria Dr. Ashwell considers "essentially to consist in excitement and irritation of the numerous and important nerves supplying the reproductive system." There are few practitioners but have been deceived by this proteiform malady into the belief of the existence of important affections, and few who cannot call to mind the satisfaction they have experienced in being able to establish that certain alarming symptoms arose from the hysteric diathesis. Quite aware of this, the author yet impresses upon us that we must always remember that hysteria itself has its limits, and that not only may congestive and inflammatory diseases be mistaken for it, but that it may itself terminate in these. No one can doubt that many local affections have been too hastily classed as hysterical, and treated empirically, but we feel certain, that the prevalent error of young practitioners is to run into the opposite extreme, and treat every painful affection as if of an undoubted inflammatory nature. It is consoling to remember that "where the hysteric diathesis really prevails, recoveries sometimes occur from states in which all hope has been laid aside. Thus paralysis, and difficulty of swallowing, and great debility, are extraordinarily recovered from; and, occasionally, when phthisis and the emaciation supposed to be its direct result, have reached an apparently hopeless point, the patient most singularly and inexplicably recovers.' The author has also observed that diseases destructive of life, especially phthisis, are slower in their progress in the hysterical.

The diagnosis of a disease like hysteria, which simulates so accurately so many other affections, is both difficult and important, and is chiefly accomplished by the observance of incongruities in the assemblage or sequence of certain sets of symptoms, which, in the disease with which it is confounded, are found to be consentaneous. Even the paroxysm itself, although usually easily distinguished, may be sometimes mistaken for that of epilepsy. Marshall Hall observes that, much as the larynx may be affected

in hysteria, it remains unclosed, and we have heaving, sighing inspiration, while, in epilepsy, we find violent, ineffectual efforts at expiration. The epileptic seizure is usually more sudden, and the deprivation of consciousness more complete; and it occurs more frequently in men than women. There is seldom biting of the tongue, or frothing of the mouth, in hysteria, nor is it followed by the heavy sleep, and insensible pupil. The physiognomy of one liable to epilepsy soon becomes peculiar.

Treatment. The author truly observes that few practitioners like to be saddled with the treatment of a case of true hysteria; but he recommends those who do undertake it to thoroughly investigate the condition of the general health and of the various functions, instead of merely attacking the local symptoms which may present themselves, and which may lead him a chace over the entire frame. It too often happens that, however judiciously the treatment may be conducted, it proves of little avail. During the paroxysm, generally, little need be done beyond the application of cold water and a smelling-bottle. "It has already been observed, that consciousness is generally retained, and enough of volition, except in convulsive and epileptic hysteria, to enable the individual to avoid danger; so that as the fit, by equalizing the circulation, and by removing nervous irritation, has upon the whole a beneficial effect, restraint need form but a small part of the treatment. A lady, whom I long attended, always rejoiced when the fit was over, because it relieved her system generally, and especially her brain, from painful irritation, which had often existed for several previous days." Encouragement to use voluntary efforts to repress the paroxysm, cautiously practising on the fears of the patient, or the swallowing of iced water, have each been found useful. When there is no plethora diffusible and fetid stimuli may be given; but, where plethora exists, and important discharges are suppressed, a moderate bleeding, or rather cupping low down between the shoulders, is of service. When there is great rigidity of the muscles of the head and trunk, and impaired deglutition, turpentine, or cold water glysters should be administered. The mustard bath, as high as the knees, is a good derivative, and “on some occasions I have known the attack quickly terminated by ringing a loud and shrill-sounding bell close to the ear for several minutes." An approaching attack may sometimes be warded off by the affusion of cold water, its injection into the rectum, or the swallowing half a drachm of ipecacuanha.

The Treatment in the Interval,-will require modification according to several circumstances. A morbid condition of the uterine system is very frequently found in hysteria, as is seen, in girls who menstruate with difficulty, ill-assorted marriages, young widows, &c.

"I am aware it may be urged, in opposition to these opinions, that structural lesions of the uterus are very common in women who have never had hysteria. Of the truth of this statement, to its full extent, I am more than doubtful: as I have accurately ascertained, both in hospital and private practice, that such individuals are by no means, especially in early life, so exempt from this common malady nor must it be forgotten, although there are exceptions, that these affections generally do not occur until the reproductive faculty is either about to cease

naturally, or has become seriously impaired by the progress of these organic changes." 230.

Although plethora is not a common accompaniment, yet it is occasionally found, when there is defective menstruation, slothful habits, suppressed evacuations, &c.; and the usual remedies for this condition may avert the attacks, and if persevered in, in a modified manner, remove the disposition to them. Agreeing with the author in these views, we may observe, that the plethora is often rather apparent than real, and the existence of hysteria affords a prima-facie probability that depletory measures, to any extent, or for long continuance, will not be borne. The case of hysteria with debility is, Dr. Ashwell observes, far more common, and when this is, as is often the case, complicated with some local vascular congestion or excitation, it requires delicate treatment. A case in which local depletion and counter-irritation are to be combined with a good diet and tonics. The gastro-intestinal disorder, often attendant upon hysteria, may produce great tenderness in the hypogastric region, relievable by leeches applied to the abdomen or to the anus, or excessive flatulence, frequently itself inducing a paroxysm. This last is to be thus treated-" a small tumbler of water, as hot as it can be swallowed, during or immediately after the meal, with some powdered ginger, a little brandy, sal volatile, or a few grains of Cayenne pepper entirely dissolved in it, seldom fails to afford relief: friction by the hand or flesh-brush over the abdomen, and in really severe cases, the injection of a pint of hot water into the rectum, with or without assafoetida, may be tried."

The diet must be simple, nutritious and slightly stimulating, and the irritation of worms, or fæcal accumulations guarded against by the use of purgatives.

Treatment of peculiar Symptoms.-Notwithstanding the general treatment employed these may have to be met empirically. Headache, and its treatment, have already been considered in the former part of the work. In this distressing and obstinate malady the author has often found the following draught useful. B. Tr. valer., amm., sp. eth. s. c., Sp. lav. c. àä 3ss., Tr. hyoscy. mxx. M. camph. 3x. 2da vel 3tia horâ. Pain of the left side is perhaps the most difficult of all hysterical symptoms to relieve. The author does not agree with Mr. Tate, in referring this generally to spinal affection, and has seen much harm result, both from the rough manipulations employed to ascertain whether tenderness along the column existed, and from the depletion and counter-irritation employed to relieve it. The whole armoury of the Pharmacopoeia has frequently been exhausted in vain in these cases. Dr. Ashwell has found the following liniment useful. B. Ether. rect., sp. camph., tr. opii., tr. lyttæ äā ziv. M. In regard to hysterical females acting as nurses the author observes : "It is not unimportant to observe, that although marriage often cures hysteria, women who have long suffered from its effects, rarely make good nurses. Doubtless there are exceptions to this fact; nor is it intended to be urged, that such women cannot suckle at all; nor that they may not occasionally be benefited by lactation. But where, prior to a late marriage, hysteria has existed for years, in association with extreme susceptibility, peevishness of disposition, and thinness of person, it is for the most part undesirable that such mothers should suckle their offspring. The milk is often disordered, the child's digestive system is thereby deranged, and a predisposition to nervous disease may be communicated." 258.

OF THE IRRITABLE UTERUS OR HYSTERALGIA.

"DEFINITION.-A permanent and painful sensibility of the uterus, and especially of its neck: often accompanied by increased frequency of pulse, a dry hot skin, and generally, in protracted cases, with stomach and renal derangement. The disease usually occurs during the middle period of life, and commonly prevents conception. It is exceedingly difficult to cure, even to palliate: and, it is said, that it is neither attended by, nor tends to produce change of structure.

This disease, Dr. Ashwell remarks, both as to symptoms and treatment required, resembles a permanent dysmenorrhoea. He has never met with it at an earlier age than 23, but Dewees has seen it at 18. It occurs only in the married. The severe pain and suffering characterizing the malady are much exasperated by the slightest movement or exertion, and especially by the motion imparted to the cervix, during the efforts at stool, or in passing urine. Excessive agony is also produced if the cervix be rudely touched during an examination: but Dr. Ashwell does not confirm the statement of Dr. Gooch, that the tenderness is confined to the cervix, and does not extend to the vagina. The contrary is the case, although such limitation exists in the rarer disease of acute inflammation of the cervix. The uterus is found low down in the cavity of the pelvis, or even prolapsed, and its cervix is often somewhat shortened, and expanded, and occasionally puffy and swollen, and the lips of the os are more than naturally closed. The suffering is greatest about the period of menstruation, which continues regular, but scanty. In three of the author's cases, the disease has gradually disappeared with the decline of the catamenia, without leaving any morbid condition of the cervix. He does not, however, agree with Gooch, that this is a mere state of irritation, but believes, that examination by the speculum, and the effects of remedies, both prove a condition of subacute inflammation to exist, and that, in some cases, this may go on to structural change. The predisposing causes are of difficult discovery, for, although the disease chiefly occurs in those of a highly nervous temperament, it may do so in the robust. Life is seldom in danger, but the case is always tedious, and even the degree of relief to be obtained, and freedom from frequency of relapse, will much depend upon the perseverance and quietude of the patient. The treatment is very much like that already recommended by the author for dysmenorrhoea. Repose is essential, perhaps for months; active purging is injurious: a generous yet non-stimulant diet is requisite: steel in moderate doses and long-continued, and narcotics in small quantities, and frequently varied, are the best medicines. Low diet, drastics, close rooms, and general bleeding are injurious. In several cases Dr. Ashwell has found the scarification of the cervix, as recommended by Mr. Fenner, or applications of leeches to that part, very beneficial. This is only the case when there is evidence of encreased congestion and vascularity, which indeed are usually present; but in simple neuralgia, when the cervix is even small and shrivelled, change of air, sea voyage, chalybeates, and means of that description, are to be employed. Pessaries, even where no marked uterine descent exists, provided the vagina be not too tender